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AIDS and Behavior

, Volume 23, Issue 10, pp 2870–2878 | Cite as

Limited Knowledge and Lack of Screening for Acute HIV Infection at Primary Care Clinics in High-Prevalence Communities of New York City

  • Javier Lopez-RiosEmail author
  • Timothy Frasca
  • Marcia J. Kindlon
  • Theresa M. Exner
  • Andrea Norcini Pala
  • Milton L. Wainberg
  • Yvette Calderon
  • Richard Cotroneo
  • Arismendi A. Jiménez
  • Robert H. Remien
Original Paper

Abstract

Diagnosis and treatment of acute HIV infection (AHI) is crucial for ending the HIV epidemic. Individuals with AHI, who have high viral loads and often are unaware of their infection, are more likely to transmit HIV to others than those with chronic infection. In preparation for an educational intervention on AHI in primary health care settings in high HIV-prevalence areas of New York City, 22 clinic directors, 313 clinic providers, and 220 patients were surveyed on their knowledge and awareness of the topic from 2012–2015. Basic HIV knowledge was high among all groups while knowledge of AHI was partial among providers and virtually absent among patients. Inadequate knowledge about this crucial phase of HIV may be impeding timely identification of cases in the primary care setting.

Keywords

Acute HIV infection Primary care Healthcare providers Knowledge and screening 

Resumen

El diagnóstico y tratamiento de la infección aguda para el VIH (AHI por sus siglas en inglés) es crucial para detener la epidemia del VIH. Las personas con AHI, quienes tienen cargas virales altas y a menudo desconocen de su infección, son más propensas a transmitir el VIH a otras personas que aquellas con una infección crónica. En preparación para una intervención educativa sobre la AHI en clínicas de cuidado de salud primaria, localizadas en áreas de alta prevalencia para el VIH de la ciudad de Nueva York, 22 directores de clínicas, 313 proveedores de salud, y 220 pacientes fueron encuestados sobre su conocimiento de la AHI del 2012 al 2015. Todos los grupos demostraron alto conocimiento básico acerca del VIH. Sin embargo, los proveedores de salud demostraron conocimiento parcial acerca de la AHÍ, mientras que los pacientes prácticamente desconocían sobre la AHI. El conocimiento inadecuado sobre esta fase crucial del VIH puede impedir la identificación oportuna de casos de AHI en sectores de la salud primaria.

Notes

Acknowledgments

This research was supported by grant R01 MH092187 (PI: Robert H. Remien, Ph.D.) from the National Institute of Mental Health (NIMH). Additional support came from a center NIMH Grant P30 MH43520 to the HIV Center for Clinical & Behavioral Studies at the New York State Psychiatric Institute and Columbia University (PI: Robert H. Remien, Ph.D.).

References

  1. 1.
    Ambrosioni J, Junier T, Delhume C, et al. Impact of HAART on the molecular epidemiology of newly diagnosed HIV infections in Geneva. Switzerland AIDS. 2012;26(16):2079–86.CrossRefGoogle Scholar
  2. 2.
    Brenner BG, Roger M, Routy J-P, et al. High rates of forward transmission events after acute/early HIV-1 infection. J Infect Dis. 2007;195:951–9.CrossRefGoogle Scholar
  3. 3.
    Chibo D, Kaye M, Birch C. HIV transmissions during seroconversion contribute significantly to new infections in men who have sex with men in Australia. AIDS Res Hum Retrov. 2012;28:460–4.CrossRefGoogle Scholar
  4. 4.
    Lee CC, Sun YJ, Barkham T, Leo YS. Primary drug resistance and transmission analysis of HIV-1 in acute and recent drug-naive seroconverters in Singapore. HIV Med. 2009;10:370–7.CrossRefGoogle Scholar
  5. 5.
    Chéret A, Bacchus-Souffan C, Avettand-Fenoë V, et al. Combined ART started during acute HIV infection protects central memory CD41 T cells and can induce remission. J Antimicrob Chemother. 2015;70:2108–20.PubMedGoogle Scholar
  6. 6.
    Pinkerton SD. How many sexually-acquired HIV infections in the USA are due to acute-phase HIV transmission? AIDS. 2007;21:1625–9.CrossRefGoogle Scholar
  7. 7.
    Prabhu VS, Hutchinson AB, Garnham PG, Sansom SL. Sexually acquired HIV infections in the United States due to acute-phase HIV transmission: an update. AIDS. 2009;23:1792–4.CrossRefGoogle Scholar
  8. 8.
    Xiridou M, Geskusa R, deWit J, Coutinho R, Kretzschmar M. Primary HIV infection as source of HIV transmission within steady and casual partnerships among homosexual men. AIDS. 2004;18:1311–20.CrossRefGoogle Scholar
  9. 9.
    Miller WC, Rosenberg NE, Rutstein SE, Powers KA. The role of acute and early HIV infection in the sexual transmission of HIV. Curr Opin HIV AIDS. 2010;5(4):277–82.CrossRefGoogle Scholar
  10. 10.
    Pilcher CD, Tien HC, Eron JJ, et al. Brief but efficient: acute HIV infection and the sexual transmission of HIV. J Infect Dis. 2004;189(10):1785–92.CrossRefGoogle Scholar
  11. 11.
    Hall HI, Holtgrave DR, Maulsby C. HIV transmission rates from persons living with HIV who are aware and unaware of their infection. AIDS. 2012;26(7):893–6.CrossRefGoogle Scholar
  12. 12.
    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505.CrossRefGoogle Scholar
  13. 13.
    Skarbinski J, Rosenberg E, Paz-Bailey G, et al. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175(4):588–96.CrossRefGoogle Scholar
  14. 14.
    Remien RH, Higgins JA, Correale J, et al. Lack of understanding of acute HIV among newly-infected persons—implications for prevention and public health: the NIMH multisite acute HIV infection study: II. AIDS Behav. 2009;13(6):1046–53.CrossRefGoogle Scholar
  15. 15.
    Siegler AJ, Sanchez T, Sineath RC, Grey J, Kahle E, Sullivan PS. Knowledge and awareness of acute human immunodeficiency virus infection among mobile app-using men who have sex with men: a missed public health opportunity. Open Forum Infect Dis. 2015;2(1):1–4.CrossRefGoogle Scholar
  16. 16.
    Grijsen ML, Steingrover MF, Wit FWNM, et al. No treatment versus 24 or 60 weeks of antiretroviral treatment during primary HIV infection: the randomized Primo-SHM trial. Plos Med. 2012;9(3):e1001196.CrossRefGoogle Scholar
  17. 17.
    Hecht FM, Wang L, Collier A, et al. A multicenter observational study of the potential benefits of initiating combination antiretroviral therapy during acute HIV infection. J Infect Dis. 2006;194(6):725–33.CrossRefGoogle Scholar
  18. 18.
    Oxenius A, Price DA, Easterbrook PJ, et al. Early highly active antiretroviral therapy for acute HIV-1 infection preserves immune function of CD8 + and CD4 + T lymphocytes. Proc Natl Acad Sci USA. 2000;97(7):3382–7.CrossRefGoogle Scholar
  19. 19.
    Centers for Disease Control and Prevention & Association of Public Health Laboratories. Laboratory testing for the diagnosis of HIV infection: updated recommendations, 2014. http://dx.doi.org/10.15620/cdc.23447. Accessed Aug 30, 2018.
  20. 20.
    Delaney KP, Hanson DL, Masciotra S, Ethridge SF, Wesolowski L, Owen SM. Time until emergence of HIV test reactivity following infection with HIV-1: implications for interpreting test results and retesting after exposure. Clin Infect Dis. 2017;64(1):53–9.CrossRefGoogle Scholar
  21. 21.
    New York State Department of Health AIDS Institute. HIV testing guideline, 2016. http://www.hivguidelines.org/adult-hiv/testing-diagnosis/hiv-testing. Accessed Aug 30, 2018.
  22. 22.
    Grimes RM, Hardwicke RL, Grimes DE, DeGarmo DS. When to consider acute HIV infection in the differential diagnosis. Nurse Pract. 2016;41(1):1–5.CrossRefGoogle Scholar
  23. 23.
    Hoenigl M, Green N, Camacho M, et al. Signs or symptoms of acute HIV infection in a cohort undergoing community-based screening. Emerg Infect Dis. 2016;22(3):532–4.CrossRefGoogle Scholar
  24. 24.
    Richey LE, Halperin J. Acute human immunodeficiency virus infection. Am J Med Sci. 2013;345(2):136–42.CrossRefGoogle Scholar
  25. 25.
    Hightow-Weidman LB, Golin CE, Green K, Shaw ENP, MacDonald PDM, Leone PA. Identifying people with acute HIV infection: demographic features, risk factors, and use of health care among individuals with AHI in North Carolina. AIDS Behav. 2009;13(6):1075–83.CrossRefGoogle Scholar
  26. 26.
    Stekler JD, Baldwin HD, Louella MW, Katz DA, Golden MR. ru2hot?: A public health education campaign for men who have sex with men to increase awareness of symptoms of acute HIV infection. Sex Transm Infect. 2013;89(5):409–14.CrossRefGoogle Scholar
  27. 27.
    Sudarshi D, Pao D, Murphy G, Parry J, Dean G, Fisher M. Missed opportunities for diagnosing primary HIV infection. Sex Transm Infect. 2008;84(1):14–6.CrossRefGoogle Scholar
  28. 28.
    Green LW, Kreuter MW. Precede-Proceed. Health program planning: an educational and ecological approach. 4th ed. New York: McGraw-Hill; 2005.Google Scholar
  29. 29.
    Armstrong BJ, Kalmuss D, Franks M, Hecker G, Bell D. Creating Teachable moments: a clinic-based intervention to improve young men’s sexual health. Am J Mens Health. 2010;4(2):135–44.  https://doi.org/10.1177/1557988309331796 Epub 2009 Mar 16.CrossRefPubMedGoogle Scholar
  30. 30.
    Patel SN, Golin CE, Marks G, et al. Delivery of an HIV prevention counseling program in an infectious diseases clinic: implementation process and lessons learned. AIDS Patient Care STDS. 2009;23(6):433–41.CrossRefGoogle Scholar
  31. 31.
    UNAIDS. Democratizing HIV Testing: Ensuring that 90% of all people living with HIV know their HIV status. UNAIDS, Geneva. 2015. Retrieved from http://www.idc-dx.org/resources/90-90-90-democratizing-hiv-testing-ensuring-that-90-of-all-people-living-with-hiv-know.
  32. 32.
    Bekker LG, Alleyne G, Baral S, et al. Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society—Lancet Commission. The Lancet. 2018;392(10144):312–58.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Javier Lopez-Rios
    • 1
    Email author
  • Timothy Frasca
    • 1
  • Marcia J. Kindlon
    • 2
  • Theresa M. Exner
    • 1
  • Andrea Norcini Pala
    • 1
  • Milton L. Wainberg
    • 1
  • Yvette Calderon
    • 3
  • Richard Cotroneo
    • 2
  • Arismendi A. Jiménez
    • 4
  • Robert H. Remien
    • 1
  1. 1.HIV Center for Clinical & Behavioral StudiesNew York State Psychiatric Institute/Columbia UniversityNew YorkUSA
  2. 2.New York State Department of HealthAIDS InstituteAlbanyUSA
  3. 3.Department of Emergency Medicine, Icahn School of MedicineMount Sinai Beth IsraelNew YorkUSA
  4. 4.Cicatelli Associates, Inc.New YorkUSA

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